PROGNOSTIC SIGNIFICANCE OF THE CLINICAL FEATURES OF MYOCARDIAL INFARCTION FOR SIX-MONTH CARDIOVASCULAR OUTCOMES DURING SGLT2 INHIBITOR THERAPY
Abstract
To assess the prognostic significance of the type of myocardial infarction (MI) — Q-wave versus non-Q-wave — for major adverse cardiovascular events (MACE) over 6 months in patients receiving early initiation of the sodium–glucose cotransporter-2 inhibitor (SGLT2i) empagliflozin. A total of 251 patients with acute MI were included and divided by infarction type into two groups: Q-wave MI (n=131; 52.2%) and non-Q-wave MI (n=120; 47.8%). All patients (100%) received empagliflozin during the acute phase (median dose 10 mg), against a background of high adherence to guideline-recommended therapy: statins — 96.0%, acetylsalicylic acid — 90.8%, P2Y12 inhibitors — 94.0%, beta-blockers — 90.8%, and mineralocorticoid receptor antagonists (MRAs) — 77.7%. The composite endpoint was MACE (death, non-fatal recurrent MI, hospitalization, and emergency PCI). Between-group differences were analyzed using Fisher's exact test, with calculation of the odds ratio (OR) and 95% confidence interval (CI). Given identical empagliflozin therapy, the groups were comparable with respect to antiplatelet prescribing; however, patients with Q-wave MI significantly more often received beta-blockers (96.2% vs. 85.0%; p=0.004), MRAs (85.5% vs. 69.2%; p=0.002), and loop diuretics (30.5% vs. 18.3%; p=0.028), reflecting a greater extent of myocardial injury. Over the 6-month follow-up, MACE were recorded in 41 (31.3%) patients in the Q-wave group versus 21 (17.5%) in the non-Q-wave group (OR 2.15; 95% CI 1.17–3.84; p=0.013). The increased risk was driven predominantly by repeat hospitalizations — 20.6% vs. 10.0% (OR 2.34; 95% CI 1.11–4.70; p=0.023), the only component to reach significance on individual analysis. Mortality (6.1% vs. 3.3%; p=0.382) and the rate of emergency PCI (4.6% vs. 0.8%; p=0.122) were numerically higher in Q-wave MI but did not reach statistical significance.
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